ArticleThe Lancet regional health. Western Pacific2020
The competence of village clinicians in the diagnosis and management of childhood epilepsy in Southwestern China and its determinants: A cross-sectional study.
Article in The Lancet regional health. Western Pacific, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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10 citing papers in PubMed, 12 citations in OpenAlex.
- Global trends in epilepsy and the Chinese experience: Epidemiological transitions, underlying mechanisms, and integrated strategies (1990-2021).Neuroprotection (Chichester, England) · 2026Review
- Phenobarbital monotherapy for convulsive seizures in rural Northwest China: a 12-year longitudinal study.Acta epileptologica · 2026Article
- Semiology Extraction and Machine Learning-Based Classification of Electronic Health Records for Patients With Epilepsy: Retrospective Analysis.JMIR medical informatics · 2024Article
- Primary care quality and provider disparities in China: a standardized-patient-based study.The Lancet regional health. Western Pacific · 2024Article
- The impact of provider-patient communication skills on primary healthcare quality and patient satisfaction in rural China: insights from a standardized patient study.BMC health services research · 2024Article
- Quality of primary health care for chronic diseases in low-resource settings: Evidence from a comprehensive study in rural China.PloS one · 2024Article
- Are Rural Primary Care Providers Able to Competently Manage Common Illnesses? A Cross-Sectional Study in Rural Sichuan, Western China.Healthcare (Basel, Switzerland) · 2022Article
- The Role of Village Doctors in Residents' Uptake of Eye Screening: Evidence from Ageing Residents in Rural China.Healthcare (Basel, Switzerland) · 2022Article
- Measurements of quality of village-level care and patients' healthcare-seeking behaviors in rural China.BMC public health · 2021Article
- Primary care providers are, fundamentally, risk managers - And this is a challenge for health policy.The Lancet regional health. Western Pacific · 2020Article
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Authors and funding
9 authors at 6 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDue to lack of neurologists in low- and middle-income countries, communities of patients living with epilepsy are calling for task-shifting of diagnosis and management from physicians to paramedical providers in the primary health care systems to narrow the huge treatment gap. Evidence to guide this work has been limited. This study assesses the competence of village clinicians (VC)- mostly paramedical providers- in the diagnosis and management of a presumptive case of childhood epilepsy and its determinants.
methodsA cross-sectional study was conducted in rural areas of a province in Southwestern China from July 2017 to January 2018. We randomly selected 370 VCs who practiced Western medicine and assumed the main responsibility of providing medical services in his/her clinic. A standardized clinical vignette based on national clinical practice guidelines was used to evaluate clinicians' competence in three domains: number and proportion of recommended (and essential) checklist (questions, examinations, and tests) completed, correctness of diagnosis, and correctness of case management.
findingsThough VCs completed 14•3% (IQR 9•5%-19•1%) of the recommended checklist, 63•2% (234/370, 95%CI 58•2%-68•0%) provided a correct diagnosis. Only 1•6% of VCs (6/370, 95%CI 0•7%-3•5%) gave correct management with both correct medication and referral, however 90•3% (334/370, 95%CI 86•8%-92•9%) provided partially correct management by referring patients to upper-level health facilities (89•5%, 331/370, 95%CI 85•9%-92•2%) or prescribing anti-epileptic drugs (AEDs) correctly (0•8%, 3/370, 95%CI 0•3%-2•4%). Around 1/4 VCs referred patients to Township Health Centers which usually were not staffed with pediatric neurologists. Fewer provided helpful medical advice to patients for daily management. The heuristic process was found to be negatively associated with the proportion of the recommended checklist that VCs completed, which is positively associated with correctness of diagnosis.
interpretationMost VCs could diagnose and refer childhood epilepsy patients correctly; however, they lacked competence when it came to assuming the responsibility of primary care providers, referring efficiently, refilling AEDs, as well as supervising and instructing daily management of patients.
fundingHY received the funding for this study from the "
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